Summary

The risks to humans from avian flu are low, but it is possible that current outbreaks in birds could at some point develop into a human flu pandemic which would be much more serious.

The risk of avian flu to British nationals visiting countries affected by avian flu is believed to be very low. There is no reason not to travel to these countries.

The risk of avian flu to British nationals living overseas in countries affected by avian flu is also currently very low; but they should take personal responsibility for their own safety in the event of a future pandemic, including considering their access to adequate healthcare.

All those visiting or living in countries affected by avian flu should follow sensible precautions.

Introduction

The World Health Organization (WHO) has warned that recent outbreaks of bird flu, also known as avian influenza, could trigger a future human flu pandemic. This factsheet explains why there is international concern about this. It describes sensible precautions for travellers and residents in affected areas, both in respect of avian influenza, and a possible future human flu pandemic. And it sets out the measures taken by the Foreign & Commonwealth Office and its diplomatic posts abroad (Embassies, Consulates and High Commissions) in response to these concerns.

Current situation

Experts began monitoring a form of avian influenza - known as the highly-pathogenic H5N1 (or A/H5N1) strain - eight years ago. Since the end of 2003, there have been a series of outbreaks amongst poultry and wild birds, starting in South-East Asia. Azerbaijan, Cambodia, China, Croatia, Cyprus, Indonesia, Japan, Kazakhstan, Laos, Malaysia, Mongolia, Nigeria, North Korea, Romania, Russia, South Korea, Thailand, Turkey, Ukraine and Vietnam have all suffered confirmed outbreaks in poultry or wild birds. Other countries are investigating suspected cases.

The WHO have issued an alert phase three, which means that there have been human infections of the virus, but very rare instances of human to human spread.
Avian influenza is largely a disease of birds. As of 6 February, 161 people have caught the disease and of these 86 have died. Human cases have been confirmed in Vietnam, Thailand, Cambodia, Indonesia, China, Iraq and Turkey. Almost all are thought to have caught the disease directly from infected poultry. Despite the spread of AI to Eastern Europe and Africa, the perceived threat of a human flu pandemic remains the same, as the virus has not shown an ability to pass easily between people.

Medical experts warn that the avian influenza virus could combine with influenza viruses already circulating in the human population or adapt into a form which could be transmitted readily between people. It is impossible to predict when this might happen. But if it did, it could trigger a global human flu pandemic.

It is important to distinguish between avian flu, the current disease affecting mainly birds, and pandemic flu, which would affect mainly humans and is at this stage only a possibility.

Precautions against avian flu

There are no specific restrictions for travellers to any of the countries affected by avian influenza, as the risk is believed to be very low. But if you plan on travelling to areas where outbreaks have been reported, you may wish to take the following precautions:
Avoid visiting live animal markets, poultry farms and other places where you might come into contact with wild, domestic or caged birds
Avoid contact with surfaces contaminated with animal faeces or fluids
Avoid eating or handling poultry, egg or duck dishes, if any of these are undercooked or raw (normal cooking destroys the avian influenza virus)
Wash hands regularly
Do not attempt to bring any live poultry products back to the UK

Most human cases are thought to have acquired their infection following exposure to dead or diseased birds. Evidence suggests that particularly risky exposure occurs during the slaughter, plucking and preparation of poultry for cooking.

Medical interventions for avian flu and pandemic flu

There is at present no vaccine against avian flu or against any future pandemic flu strain. The normal seasonal flu vaccination protects against currently circulating human influenza strains, but is unlikely to offer any protection against avian flu strains or against a new pandemic flu strain. The use of seasonal flu vaccination, by minimising numbers of cases of seasonal flu, would reduce opportunities for avian strains to mix with human strains, and may allow people with avian or pandemic flu to be more easily identified.

Anti-viral drugs, such as oseltamivir (Tamiflu ®), may be effective in reducing the severity and duration of an influenza illness, but this has not been proven in a pandemic situation and their effect may be limited if the virus develops resistance to the drugs. Further medical information is provided on the Department of Health website.

British nationals living overseas

British nationals resident overseas should be prepared to take personal responsibility for their own health in a pandemic situation, including access to adequate healthcare. Availability of anti-viral drugs is currently limited in many countries, including the UK. Should a pandemic occur, transport and healthcare systems - including the NHS - would be severely disrupted.

As a precautionary measure, those living in or near an avian influenza-affected country for an extended period might consider, with their healthcare adviser, whether they would have access to anti-virals for treatment in case of a pandemic. In a pandemic you should seek medical advice before using anti-viral drugs. British diplomatic missions overseas cannot provide medicine or medical treatment to British nationals, but may be able to advise on local availability of medicines, and provide details of healthcare providers. Where appropriate British nationals may wish to seek guidance from employers, who may also have a pandemic contingency plan in place.

A flu pandemic could spread extremely quickly and with little warning. Some countries might close their borders, international transport could be severely disrupted or halted, and travel could become medically inadvisable. In these circumstances, and because of the likely numbers involved, the FCO will not be in the position to offer repatriation to British nationals. British nationals should consider in advance the potential risks, monitor medical guidance and travel advice (on the FCO website), and make appropriate preparations. Should they plan to return to the UK, they should consider where they might stay and ensure that travel documents such as passports and visas are up to date and in order.

British nationals travelling overseas

Travellers to areas affected by avian influenza with specific health concerns should consult their usual healthcare provider for travel medical advice and further guidance. As the risks from avian influenza are considered small, the UK’s Health Protection Agency does not at present advise tourists visiting affected areas to carry anti-viral drugs. There have been no cases of avian flu in travellers.

Should the WHO change the global pandemic alert phase, the FCO will update travel advice accordingly.

International co-ordination

The British Government will continue to work with the international community to try to prevent a pandemic from arising and to provide technical assistance to those countries most vulnerable to the effects of a pandemic. At the International pledging Conference held in Beijing in January, the UK announced £20m ($35m) of new, untied finance to support this work.

Further information

The latest information on avian flu and pandemic flu, including prevention and treatment measures and other Frequently Asked Questions, can be found on the following websites:

Health Protection Agency
National Travel Health
Department of Health
Foreign and Commonwealth Office